Mod 8: Sclerotherapy, Prolotherapy, & Lubricants Flashcards

1
Q

What is Sclerotherapy?

A

Sclerotherapy involves the injection of a solution (usually salty) into a tissue such as vein or nerve.
Causes irritation in the lining of blood vessels, lymph vessels and nerves.
Leading to blood in vessels clotting, and to desiccate

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2
Q

Sclerotherapy remains the primary treatment for small vessel varicose disease of the foot and lower extremity but what do this include?

A

Telangiectasias
Venulectasias
Reticular Ectasia’s

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3
Q

What are Telangiectasias?

A

Red
Flat vessels
1mm or smaller in diameter.

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4
Q

What are Venulectasias?

A

Blue
Sometime distended above the skin
2mm or smaller in diameter

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5
Q

What are Reticular Ectasias?

A

Reticular veins
Cyanotic Hue
2-4mm in diameter

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6
Q

Which vessels respond best to Sclerotherapy, LARGE or SMALL?

A

SMALL

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7
Q

What are the major indications for using Sclerotherapy?

A

Improve cosmetic appearance
Reduce associated symptoms such as burning and pain.
To Rx remnant tributaries after endovenous laser ablation of Saph or truncal vessel.

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8
Q

Contra-indications to Sclerotherapy are?

A
Pregnancy
Thrombophlebitis
Pulmonary emboli
Hypercoagulable states
Allergy to Sclerosing agent
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9
Q

Which Diagnostic method is used to diagnose veinous disease?

A

Duplex Ultrasonography

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10
Q

Visual Sclerotherapy is what?

A

Injections without the use of Ultrasonography

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11
Q

Duplex guided Sclerotherapy (endovenous chemical ablation) is what?

A

Injection guided with Duplex Ultrasonography

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12
Q

The most common agents used in Sclerotherapy are what?

A

Hypertonic Saline (23.4%)
Sodium Tetradecyl Sulphate
Polidocanol
Chromated Glycerin

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13
Q

Should Sclerotherapy start with proximal or distal vessels?

A

Proximal: Varicose veins
Reticular veins
Talengeictasias

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14
Q

Ambulation should begin how soon after injection and compression bandage is applied?

A

IMMEDIATELY

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15
Q

What gauge needle is best used for Sclerotherapy?

A

30g bevel up to gauge depth

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16
Q

If severe pain presents this could indicate what? and how can this be alleviated?

A

Extravasation of WBC

Injecting the site with Sodium Chloride or LA will help dilute the Sclerosant.

17
Q

The areas at highest risk of ulceration are where?

A

Pretibial

Ankle

18
Q

What are the usual injection sizes? and at what interval spacing?

A

0.1-0.4ml

2-3cm intervals

19
Q

Graduated compression stocking (class 1) of 20-30mmHg should be worn for the 1st night, TRUE or FALSE? then for how long after Rx?

A

TRUE

1-3 weeks depending on vessel size

20
Q

Lower extremity exercises are to be performed immediately after Sclerotherapy however how long should aggravated exercise be avoided for?

A

4 weeks

21
Q

Compression garments reduce the incidence of transient hyperpigmentation and edema, TRUE or FALSE?

A

TRUE

22
Q

Superficial Thrombophlebitis is rare but can be treated with?

A

Compression

NSAIDS

23
Q

What is a possible cause of tissue necrosis?

A

Extravasation

Injection into an arteriole

24
Q

Massage and topical 2% nitroglycerin ointment are Rx for what?

A

Shiney white blanching associated with injection into an arteriole or spasm

25
Q

Describe alcohol ablation of a mortons neuroma?

A

Ethanol is injected around the Nerve causing neurolysis, through dehydration, necrosis, and precipitation of protoplasm

26
Q

What is the preparation of 4% ethanol sclerosis therapy?

A

2ml 4% absolute ethanol alcohol
48mls of 2% Xylocaine with epinephrine 1:100,000
1ml of this mix is injected for 5-7 weeks

27
Q

Prolotherapy works by?

A

Claims to strengthen inadequate ligaments, tendons, and produce cartilage by injecting them with an irritant to induce fibroblastic hyperplasia.

28
Q

Use of steroids is con current to Prolotherapy because of what?

A

Prolotherapy induces inflammation and steriods reduce inflammation.

29
Q

Prolotherapy preparations include?

A

P2G (phenol, glucose, glycerin)

Dextrose

30
Q

OA can now be Rx by intra-articular injection of a lubricant, what is this know as?

A

Viscosupplementation

31
Q

Most commonly used agent for viscosupplementation is?

A

Hyaluronic acid (Hyalgan, Synvisc)

32
Q

HYALGAN and SYNVISC are used in injections to a single joint and come in pre filled single use syringes but what is their frequency?

A

HYALGAN - 3-5 injections 1 week apart.

SYNVISC - 3 injection 1 week apart.

33
Q

Injection technique for Lubrican injection is what?

A

Strict sterile technique (not to use disinfectants containing quanternary amonium)
Use 18-22g needle to draw as much fluid from joint as poss
use different 18-22g needle to inject Viscosupplement.
*Steroids or LA should not be mixed with viscosupplement to prevent dilution
LA can be used to numb area of injection

34
Q

Care should be taken to avoid IV injection of lubricants, how might this present?

A
Rashes
Hives
Itching
Muscle pain/cramps
Flushing/swelling of face
Tachycardia
Nausea
Dizziness
Fever
Chills
Headache
Difficulty breathing
Swelling arms/legs
Rare cases decreased platelet level
35
Q

Following Lubricant injection post op information should include?

A

Information about possible side effects: Pain, swelling, restricted motion.
If necc - Rest, Ice, Heat, NSAIDS
Avoid High impact activity for 48hrs